A&E in England sees worst ever delays in January, leak suggests

A&E patients in England experienced the worst month of delays in January since a four-hour target was introduced 13 years ago, leaked figures suggest.

Provisional data passed to the BBC says an unprecedented number of patients spent longer than the target time waiting to be seen in emergency wards in January.

It showed that more than 60,000 people waited between four and 12 hours for a hospital bed. And more than 780 waited more than 12 hours. Both figures are record highs since the introduction in 2004 of a target that 95% of patients must be seen and either admitted or discharged in under four hours.

The leaked document from NHS Improvement suggests that out of 1.4m visits in January, only 82% were dealt with within the four-hour target.

The NHS Providers chief executive, Chris Hopson, said: “These figures have not been verified and should therefore be treated with caution, but they are in line with the feedback we have been getting from trusts.

“NHS staff have responded magnificently to increased winter pressures, but the situation has become unsustainable. The rise in long trolley waits is particularly worrying, as there is clear evidence they can lead to worse outcomes for patients.”

Hospitals have not hit the target nationally since the summer of 2015.

A Department of Health spokesman said the January data was yet to be verified and that official figures, due out on Thursday morning, only covered December.

He said: “We do not recognise these figures – it is irresponsible to publish unverified data and does a disservice to all NHS staff working tirelessly to provide care around the clock.

“Despite the pressures of winter, the vast majority of patients are seen and treated quickly and hospitals have detailed plans in place to manage busy periods – supported by an extra £400m of funding.”

Dr Mark Porter, chair of the British Medical Association council, said delays in A&E were a symptom of a bigger crisis in social care, which the government was failing to grasp.

“When social care isn’t available, patients experience delays in moving from hospital to appropriate ongoing care settings – preventing patients being admitted at the front end in A&E,” he said.

“The prime minister cannot continue to bury her head in the sand as care continues to worsen.”

A&E in England sees worst ever delays in January, leak suggests

How to avoid temptation during dry January | Abi Wilkinson

There’s no better time to try and quit booze than in January. Following weeks of festive over-indulgence, at least some of the people around you are also likely to be thinking about cutting down. Requesting a lime and soda rather than your usual gin and tonic when someone gets a round often elicits an understanding nod. “Dry January, is it?” The best option in this scenario is to simply smile in agreement. The alternative, as I learned the hard way, is awkwardly attempting to explain why you’re hoping to make it a permanent thing, as your conversational partner decides whether to feel pitying or judged.

Perhaps we should be encouraged to talk about the issue more openly. As things are, though, telling people on a boozy night out that you think you were developing an unhealthy relationship with alcohol tends to go down like a lead balloon. Though it never became the kind of dependency that requires professional intervention, over the past year or so I found myself relying on booze to lift my mood. The combination of Brexit, Trump, Labour politics and personal issues left me feeling hopeless and depressed. I began to fixate on the issue of climate change and the details of a potential future apocalypse. Only when I had a few drinks inside me did I feel capable of switching off.

It doesn’t help that my friends are used to me being the first to suggest a round of shots or a third bottle of wine

Over Christmas I came down with flu and spent a couple of weeks laid up in bed. I realised that increased drinking probably hadn’t left me in peak physical condition, and by the time I felt well again I was determined to keep it that way. The idea of risking a hangover filled me with dread. I also figured out that my political despair was exacerbated because I also felt I’d lost control over my own life, and that alcohol was part of the problem. It was a vicious circle I was determined to break and new year seemed like an obvious time to start.

I quickly stopped trying to explain my reasoning to enquiring acquaintances. The popularity of dry January has definitely made it easier to decline booze without awkwardness, but there have been a couple of incidents where I’ve had to stand my ground. It doesn’t help that so many of my friends are relatively heavy drinkers – nor that they’re used to me being the first to suggest a round of shots or a third bottle of wine.

I’ve discovered that the best option is to be proactive. If I’m going somewhere where people are drinking, I’ll mentally prepare for being pressured to participate and think about how to avoid temptation. It’s only been a couple of weeks so far, but I’ve found a few tactics that might be helpful for others:

1. Make sure you’ve always got a (soft) drink in your hand

This is simple but effective. It’s not just because of the alcohol that drinking works as a social lubricant – taking a sip is also an effective way to fill any awkward gaps in conversation, and going to the bar provides a handy exit strategy if you’re feeling trapped. Holding a drink also gives you something to do with your hands, which is more useful than I’d previously appreciated. What’s more, when someone’s getting a round in you can simply to point to your almost full glass. No awkward explanation required.

2. Realise you can still have fun

At the age of 26 I’ve made a miraculous discovery: I don’t actually have to be drunk to dance in public. When everyone around you is feeling happy and unselfconscious, it’s surprisingly easy to catch their good mood. (Especially when you remember that you’re the only one who’s not going to wake up with a headache.) If you’re heading to an event where people will be drinking, go with the expectation that you’ll enjoy yourself. Otherwise, what’s the point?

3. If you’re not going to have fun, don’t bother going out

If you’re feeling tired, anxious or stressed, step two might work. Sometimes I’m just not in the mood to socialise. My previous approach to this situation involved quickly downing a couple of drinks in an attempt to get in the mood, but I’ve realised I’m far better off making my excuses and curling up at home with Netflix and a takeaway. If you get somewhere and realise you’re not feeling it, it’s fine to prioritise your own wellbeing and slip off early.

4. Find social activities that don’t involve drinking

If, like me, your social life tends to mainly revolve around the pub, consider having a go at something else. Your friends might drag their feet a little, but if you’re prepared to do most of the organising, most people can be roped in. Art galleries and museums, the cinema, rollerskating, bowling – going out for food also makes alcohol less of a focus. Along with a couple of female friends, I’ve started regularly visiting the local Turkish baths.

5. Come up with alternative ways to reward yourself

Overexcited by various “new year, new you” guides, I originally considered cutting out sugar at the same time as quitting alcohol. This was a terrible idea. Whenever I had a difficult day and wanted to treat myself for getting through it, my usual solution was to reach for the bottle. Failing that, I’d opt for a bar of chocolate or a slice of cake. If I tried to drop both at once I’d be setting myself up to fail. Whether it’s sugar, video games or watching Ryan Gosling films, it helps to find alternate ways to give yourself a dopamine hit.

How to avoid temptation during dry January | Abi Wilkinson

NHS could face its worst January as it struggles with festive backlog, warns doctor

The NHS is facing “potentially the worst January” ever as it struggles to deal with the backlog of patients occupying beds over Christmas, a leading doctor has warned.

Dr Mark Holland, president of the Society for Acute Medicine (SAM), said hospitals had already seen large numbers of elderly patients over the festive period and that the health service was on the brink of a major crisis.

Holland, who is based in Manchester, said hospitals were operating under a “false sense of security” as elective procedures dipped during the Christmas period with those beds becoming available for emergency patients.

Once routine operations start up regularly this week, hospitals must make these allocated beds available again. A bout of flu, the winter vomiting virus, or even a cold snap, could prove the tipping point, he warned.

He said the service was going to face the health equivalent of the “credit card bill from hell” after the festive period and called on the government to announce its contingency plans for a “possible worst-case scenario”.

Holland, who leads the national body for acute hospital staff, told the Press Association: “There’s this problem over Christmas and New Year where actually, because you get this glut of beds that become available, you’re just building trouble up for ourselves in January.

“And then … when the flu kicks in, if the winter vomiting virus kicks in, which would potentially close a ward, or if there’s just a cold snap – when any of these things occur we will be under more pressure, but actually we’ll still be spending most of January trying to clear the Christmas and New Year backlog.”

This year January could be “one of the worst we have faced” due to record numbers of elderly patients who cannot be discharged because they are waiting for social care, he said.

Using an analogy of Christmas spending Dr Holland said it was down to the balance of beds within hospitals. “Imagine, at the end of January, we are going to get our credit card bill for Christmas,” he said.

“However, this January its like we’ve not paid last month’s credit card bill, we’ve not paid November’s credit bill, and over Christmas we’ve gone out and had a really good spend. The credit card bill we are going to get from January is just the credit card bill from hell … it’s going to be the worst ever credit card bill for the NHS.”

There were currently “too many unknowns to tell us if we will be able to get through January and avert a major crisis”, he added.

NHS could face its worst January as it struggles with festive backlog, warns doctor

Dr Le Fanu"s on-line overall health clinic, Friday 31st January 2014

Dear Doctor,

I have had the same problem as the query on Monday Jan 20th and will try to keep this as brief as possible.

12 years ago pain in one ear started – I was at first able to cup my ear but that didn’t last long. It felt as if something pointed but not sharp was pressing on my ear. Over the subsequent years I have had dental work done, years on anti-inflammatory medication including antidepressants, and an operation on my nose and I have lost track of the antibiotic courses. I have seen Audio-mandible consultants, ear, nose and throat consultants all to no avail. I was shouted at by one ENT chap “There is nothing wrong with your ear.”

I have a very sympathetic GP who keeps referring to new consultants, recently for a sinus problem for which I was given Clarithromycin for one month, then for three months. Halfway through this last course my ear became distressingly painful and it occurred to me that the only thing not tried was for a fungal infection. I got a cream containing Clotrimazole 1% which became gritty so I thought something was working and bought some drops that I used for 5 days. The drops made me deaf (muffled sound). I continue to use the cream when I need to e.g. after washing my hair when it starts to return – I can sleep on that ear. It seems to me that the problem was in the neck of the ear and the shell and so out of sight of any scope inserted into the ear.

Do hope this helps.

Best wishes, Pauline D

Dear Pauline D,

Thanks for your comments on the puzzle of the painful ear. There has been much correspondence on this matter that features in the forthcoming Monday column (3rd Feb). The general gist is that the best way of dealing with it is by alleviating pressure on the ear but yours is the only suggestion that a fungal infection might be implicated.

Dr Le Fanu,

I am 62, male and fairly fit. Every winter I have the same problem and every winter it gets worse. Unfortunately it is something which other people don’t take seriously. I have a problem with my voice. When winter starts and the central heating comes on I just need to speak for 10 minutes and I start to get hoarse. Continuing to speak leads to a sort of sore throat and a headache at the back of my neck. I read once about nodules on the larynx and went to see a specialist at the end of 2011. He did a something-oscopy, inserting a camera through my nose and proclaimed that there was nothing to report. He said, “Face it, you are getting old and you just don’t produce enough mucous to lubricate your larynx. You’ll just have to talk less.”

Since then I have followed internet advice: installed a humidifier in the kitchen, cut out diuretic drinks like wine and coffee, stopped eating spicy foods and stopped speaking unless I have something really important to say. Every night we sleep with the window open (a humidifier in the bedroom is too noisy). The result is that I feel OK on wet, damp days and much worse on dry, cold days. I have almost stopped talking to my wife and at breakfast and dinner have a pile of scrap paper on the table for me to write notes. On some days I have to stay in the kitchen to be in the more humid atmosphere. Earlier today I drove to town (15 minutes) and even after that short space of time I could feel my throat drying badly. For a long drive in the car I have to chew gum to force myself to swallow frequently. I have always hated the idea of chewing gum. Finally, I am now trying to train myself to speak whilst exhaling and this produces a strange effect in normal conversation.

Will this ever get better?

Best regards,

Chris W

Dear Chris W,

Thanks for being in touch. I would concur with the ENT specialist that this hoarseness is due to an age related loss of lubrication of the vocal chords exacerbated by dry environment. It is very disappointing that it should persist despite the several steps you describe though it might be worthwhile discussing with your doctor a trial of the acid suppressant drug Losec as acid reflux can be an exacerbating factor.

Beyond that there is an interesting list of ‘folk remedies’ on the website health911.com including various teas and ginger. I note that you dislike chewing gum but its effect in increasing the amount of salivary secretions can be simulated by placing a raisin (or rolled up piece of paper or string) between gum and cheek.

Perhaps a somewhat trivial enquiry, but a tiresome problem for me. Suffering from Sjogren’s Syndrome my mouth is very dry and sleeping with an open mouth I wake several times during the night, because my tongue is like a board and most uncomfortable I use a saliva spray to try to alleviate this.

Arthritis in my neck means that it is not possible to sleep completely on my side. How can one learn to keep a closed mouth whilst asleep? This is affecting the surface of my tongue and making eating most disagreeable.

Mrs M.E.H

Dear Mrs M E H,

Thanks for your query. The simple remedy for this nocturnal dry mouth, recommended for those who snore loudly, is to tape the lips together with Micropore. I hope this does the trick!

Hello

I am a 67 years old male living in the Midlands. I retired from full time work at 50 and have spent time since involved in hobbies and travel as well as voluntary work. We have a large garden which is our joy and an extended family meaning life is full and busy. No worries re pensions and other than the following – a healthy lifestyle!

Some 7 years ago following a cruise we came home with a horrible virus infection that had been circulating the ship during our time at sea – despite our best efforts to avoid it the wife initially went down with it before passing it on to me. It was a coughing virus (cabin cough) in my wife’s case it left her on the verge of bronchial pneumonia. She has since recovered fully.

In my case it left me with constant tiredness which I call TATT – tired all the time! I get what I think is a good? nights sleep 8 hours but on waking can still be tired and every day have to go back to bed in the afternoon to get through the rest of the day. I have no problem sleeping albeit one of the tests undertaken revealed I may be bordering on sleep apnoea – my wife says that is not the case as I do not snore nor stop breathing at night! All tests undertaken have shown everything is ‘normal’ i.e. diabetes, thyroid, etc etc (too lengthy to list) although they did show up ‘para proteins’ in my system which are now monitored annually.

Blood pressure is normal but for 20 years I have suffered with high cholesterol and controlled same with statins. I stopped these over 12 months ago to see if they might be a cause.

The only other medication I take is for Nasal polyps which I have stopped at times for several months without any change in my TATT.

I have seen specialists including Endocrinologists who have tested various theories but nothing so far helps.

I try to keep fit at the Gym, am not overweight, maintain my interests in hobbies etc but the recent arrival of grandchildren means I am missing out more and on many things. None of my many friends and former colleagues – some younger – many older – can understand the situation and none of them have to go back to bed in the afternoon albeit they will all admit to 40 winks in the chair some days!

Any help or advice would be greatly appreciated as I think my GP has or is reaching the stage of exhaustion as well!!

Many thanks in anticipation and – Keep well

Dear Anon,

Thanks for being in touch and my sympathies for your TATT which has clearly been thoroughly investigated by your doctors regrettably to no avail. It could be I suppose related to your otherwise asymptomatic raised para proteins. Beyond that the onset following that viral infection is obviously suggestive of post viral ‘chronic fatigue syndrome’. This may improve with the SSRI Sertraline starting initially at a very low dose and slowly building upwards. You can find further details Google ‘Le Fanu Sertraline chronic fatigue’.

Dear Dr James,

I am a recent but now regular reader of your excellent advice column.

I would be sad to see people discouraged from taking Glucosamine/Chondroitin as it has done me so much good over the past eighteen years (I am now mid-sixties). I have three joint problems. One needs specific exercises (a knee), another needs rest and careful use (a shoulder) and the third, a hip, needs the supplement which I started without any other changes to my regime which could explain the benefit. If I become too complacent about it, and leave off the Glucosamine for a while, I soon find myself having to start again on the maximum dosage for a week or so. The only negative side effect is the cost but I certainly would not pay for something that I didn’t think was worth it. On the other hand, there is no point in taking it for a joint problem for which it is not suitable.

Regarding the young woman back from West Africa with a one-sided headache, blocked ear and vertigo perhaps I could mention that these were the first acute symptom one of my own family had of severe hypothyroidism (though without the numbness mentioned) following swine flu? It sounds as if the young lady has been thoroughly checked over but diagnosis and treatment of thyroid issues is so far from ideal that I thought it worth suggesting. And, of course, we have personal and anecdotal evidence of the difficulty of identifying tropical illnesses and parasites.

With my best wishes and thanks again for all the problems and advice shared,

Marion D

Dear Mrs M D,

Thanks for being in touch and your kind comments about the column. The jury on glucosamine is divided with some, like yourself, convinced of its merits while others (surprisingly) maintaining it exacerbates their symptoms. This may be related to the type of glucosamine with the suggestion that the hydrochloride form is superior to the sulphate. Thanks too for your comments about this week’s medical conundrum.

My damaged spleen was removed 20 years ago after a road accident. Following advice, I take penicillin V twice daily and Pneumovax booster every 5 years. I have also received Hib and meningococcal C vaccines. Do these vaccines require 5 yearly boosters? I have not received meningococcal A vaccine. Should I also ask for this? My immunity is also compromised because I have rheumatoid arthritis and receive Abatacept monthly by infusion.

Many thanks. Kieran C

Dear Kieran C,

Thanks for being in touch. Both meningococcal vaccines are recommended for those who have had a splenectomy though the schedule might need to be modified in view of your taking Abatacept. You should obviously see specialist advice on this.

Dear Dr James Le Fanu,

About 12 months ago my wife (84) was told she might have Senile Tremor as she was suffering shaking in the trunk. There is no shaking of the limbs. This gradually got worse and eventually our GP arranged for a consultant to see her. His report in October 2013 thought it was this or the start of Parkinson’s Disease and arranged for a Brain scan. He is satisfied it is not Parkinsons. He wanted to see her again in “a few months time” to see how it was progressing. It got very much worse making it difficult to stand without support but could walk slowly with a stick. Eventually the shaking got so bad that sometimes it was a very heavy shudder at about 1 second intervals. It has weakened her and other troubles not related has made her almost housebound if I were not fortunate to be fit enough for 86 to help her. It seems that our GP isn’t in the same NHS Trust as the consultants Hospital which seems to keep him out of the picture unless we keep him up to date and we don’t get the backup I think we might expect at our age. What happened to “Well Women’s Clinics” The nearest we’ve been offered seems to be a meeting of various old sufferers who compare their problems with each other which is no help at all. The consultant has suggested an appointment at his Clinic in May !!! The tablets prescribed this month have reacted so badly with my wife’s stomach that she is not taking them and although we have reported this to his secretary we have had no reaction.

Is there some organisation dedicated to this frightening disease or some particular expert who could help us find some relief or treatment. The Internet doesn’t appear to help in this case.

Regards

Dear Anon,

Thanks for being in touch and my sincere sympathies for your wife’s current problems. I note the consultant has excluded Parkinsons but you do not mention the findings of the CT which I presume did not identify any obvious cause of her symptoms. The shaking of the trunk is certainly suggestive of some disturbance of the coordinating centre at the back of the brain known as the Cerebellum. I would agree that the deterioration in her symptoms would warrant an earlier follow up appointment with her neurologist with a view to obtaining a specific diagnosis and prognosis.

Dear Dr James

I’m wondering if you are in a position to assist with an ongoing problem.

Back in August last year I experienced a chip seemingly getting stuck in my throat and remaining there for several days despite my attempts to dislodge it. Eating and swallowing caused discomfort and I had an associated pain in my chest. Since then I’ve had episodes of the same sensations, accompanied by a lot of belching.

My GP prescribed Lansoprazole which has helped reduce the burning feeling of reflux. A consultant found my larynx a little red and the results of a barium swallow revealed slow transit of food through the oesophagus. There is no known treatment.

I tend to eat bland and relatively smooth foods in a bid to alleviate these symptoms but I’m wondering if there are other strategies I could adopt or any remedies that have helped others to overcome a sluggish oesophagus.

Any advice will be gratefully received.

With many thanks

Sue B

Dear Sue B,

Thanks for your query. This impaired motility or ‘sluggishness’ of the oesophagus predisposes to acid reflux and muscle spasm – hence the discomfort and improvement with acid suppressant drugs. There is some evidence that the drug Nifedipine can be of value or more drastically an operation or botox injection to alter the dynamics of the valve between oesophagus and stomach. Further details can be found on the patient.co.uk website (search oesophageal spasm) which you may wish to discuss further with your doctor.

Dear Dr Le Fanu

Would it be possible for you to highlight the dangers of the possibility of zinc poisoning through over use of denture fixatives. I am afraid we are not careful enough of reading the small print, especially of something that can be bought easily and cheaply from many outlets. Some manufacturers have woken up to the problem and advertise their produce as “zinc free”, but not all. Just a look on line will show what a large problem this is. I am so grateful to have found out the cause of my malaise early.

I am one of your “awkward squad” of Polymyalgia Rheumatica sufferers who rejected steroid treatment and I relied on disprins much against my doctor’s advice. It took several months of gently reducing the quantity taken but I was off them altogether within nine months and thus far have suffered no recurrence.

Thank you so much for your column. We never miss it.

Dear Anon,

Thanks for bringing to my attention the problem of zinc toxicity associated with the use of denture fixatives – of which I confess I was not aware. I look forward to mentioning this in an upcoming column. It is good to hear you managed to control your PMR without having to resort to steroids.

Dear Doctor Le Fanu

Further to your article in this Monday’s Telegraph regarding Primary Hyperhidrosis:

My daughter has suffered with hyperhidrosis in hands and feet for over twenty years. Examinations, school and university work was a nightmare. She decided to undergo a sympathectomy operation when 21 as a last resort when nothing else seemed to help. Fortunately this was cancelled. I say fortunately as we discovered doing further research that although this would have reduced the sweating in the hands it would have caused extra sweating in other parts of the body.

I was interested to read in your article of the drug Oxybutynin as an alternative.

However, for someone wishing to use a drug free and very effective method to reduce this embarrassing condition my daughter discovered Iontophoresis Therapy. Briefly, this is a machine which resembles the size of a laptop. It opens into two trays into which a small amount of water is put and a very small electric current is passed through whilst placing hands and then feet on electrode plates in the tray for about 5 minutes. She does this once a week and has no sweating for the remainder of the week. She has used this successfully for 4 years and it has just become part of her routine.

Needless to say this has been a life changing treatment.

The machine can also be used on other parts of the body using sponge attachments. (For more detail see IontoCentre.com)

The drug would have been a useful alternative on a recent trip of 6 months through Africa where of course she was unable to plug in a machine !

Do hope this information can be of use to other sufferers.

Yours sincerely

Dear Anon,

Thanks so much for being in touch and your interesting account of your daughter’s hyperhidrosis. It is very gratifying that it should have responded so well to the Iontophoresis treatment that I look forward to mentioning in the column for the benefit of others.

Dear Dr Le Fanu,

Both my mother and her father ( neither of whom smoked or drank alcohol), suffered from hand tremors / shaking which became just about noticeable in their 40s and got progressively worse with age. So much so that in their late 60s and 70s one had to half fill a cup to avoid spillage. Both lived into their late 80s and were in good health. In the last years of his life my grandfather had to drink his tea through a straw.

When my mother was in her 70s the shaking became very noticeable, but if she fell asleep it stopped completely. My mother had 5 children – 3 boys & 2 girls and all of the males have shaking hands.

I have suffered from it all my adult life and now that I am in my late 60s and now, just as with my mother I have to half fill a cup as in the past few years the continual shaking is getting progressively worse. I do not smoke, but do drink (socially) but I have noticed that if I have 2/3 pints the shaking stops ! but next morning is back to what it was.

I mentioned this to my doctor, who does not think anything can be done. My 2 younger brothers suffer from shaking, but not as severe as mine – yet. Also my 2 sons, 40 and 38, also are showing signs of having inherited the condition.

Do you have any advice. Many thanks

Dear Anon,

Thanks for being in touch and your classic account of the symptoms of Essential Tremor that clearly runs strongly in your family. This is best treated with a small dose of a beta blocker such as Atenolol (see T A Larson, Acta Neurol Scand, 1982 vol 66, pp 547 – 554) You should discuss this with your doctor.

Firstly, I had four episodes of vertigo from February to December last year. The last one was the worst and we had to get our GP to come to the house because I could not move out of the chair. He prescribed Buccastem 3mg tablets for the sickness. I took one tablet twice a day for two days and felt much better. My question is – should I be worried about setting off the vertigo again when I fly to Singapore to see our daughter later this year? It has been suggested that I could take travel sickness tablets for such a long flight. Is this a good idea ?

Secondly, I have read with interest pieces in your column about Multivitality 70+ tablets alleviating the swelling and joint pain of arthritis. I am 72 and have had swelling to my hands and finger joints for several years. My GP suggested that I take glucosamine, which I have done for the last ten years at least. I am prescribed 25mg Atenolol and Lanzoprazole first thing in the morning every day. My question is, is the Multivitality 70+ compatible with my prescription drugs and am I right in thinking I should stop the glucosamine if I start taking the Multivitality ?

I apologise for using your time to ask two questions, and thank you in advance for your kind attention to my queries.

Ruth J

Dear Mrs J,

Thanks for your queries. The episodes of vertigo are presumably due to the condition known as Benign Paroxysmal Positional Vertigo and it is certainly encouraging that they respond so well to the Buccastem. They could, of course, recur so you need to take a supply of medication when travelling to Singapore. Iin the meantime you should discuss with your doctor whether the Epley manoeuvre (details on the internet) might be appropriate for preventing further episodes in the future. As for the Multivitality 70+ there is no reason you should not take them with your current medication. I have the impression that the glucosamine has not been particularly very helpful so perhaps, in view of recent comments in the Monday column,you should give them a rest.

Dear Dr James,

I have a chronic medical condition which started in around 2007, and which leaves me unable to work or drive, due to unrelenting headaches, dizziness, vertigo, and a host of other symptoms besides.

Getting a formal diagnosis has proved impossible, but it’s become obvious to me that I am suffering from electro-hypersensitivity (or any of the variant names by which the condition goes).

It’s quite simple – the more exposed I am throughout the day to artificial radiofrequency/wireless radiation from technology such as mobile phone masts, cordless phones, mobiles (especially smart phones) and so on, the worse I become. And now I have the imminent rollout of smart meter technology threatening to add to my daily doses of non-ionizing radiation poisoning.

We appear to be in a situation as a society (and as a species) whereby we are rolling out layer upon layer of wireless radiation, to which we are all exposed on a 24/7 basis, with absolutely no idea of the cumulative health effects of this – although a few brave scientists, researchers and medics are starting to raise urgent concerns, and the International Agency for research on Cancer has said that “Radiofrequency electromagnetic fields are possibly carcinogenic to humans (Group 2B).”

I read the article in the Telegraph on 24th January 2014, about a French village that is desperately trying to remain a mobile-free zone, with great interest (“French village in ‘Asterix-style battle’ to be mobile network-free zone”).

What reassurance, if any, can you give electro-hypersensitivity sufferers such as me that things are ever going to improve, when in this country, the NHS seems to be constitutionally incapable of recognising the condition in the first place, and we all seem to be absolutely wedded to our wireless gadgets?

Kind regards,

Dear Anon,

Thanks for being in touch and my sympathies for these debilitating symptoms you attribute to electro-hypersensitivity. You might be interested in attending a conference on this organised by the British Society for Ecological Medicine in London on Friday 7th March.Further details can be found on the website www.bsem.org.uk .

Dear Dr,

My husband and I enjoy cruise holidays. Unfortunately every time recently he has suffered badly with swollen legs. I am attaching a photograph of them on our last cruise. He can’t get shoes on by the evening they are so swollen but, come morning, they are their normal rather skinny self! He did have a DVT in his left leg about four years ago whilst we were at home and was treated with Warfarin for a few months. He hasn’t had any trouble since. He has also had a couple of squamous cell carcinomas removed from his legs over the past five years.

Our GP isn’t very interested and just tells him to stop going on cruises. We are both in our eighties and enjoy our holidays.

I hope that you may come up with an answer!!

E G

Dear E G,

Thanks for your query and those rather alarming looking photos of your husband’s swollen legs. This problem is usually (though probably incorrectly) attributed to the allegedly high salt content of the meals served on cruise ships. I suspect, however, that as with the swollen feet associated with flying this is more likely to be a gravitational effect. The simple (and indeed only remedy) is to take a daily dose of the diuretic or water tablet Frusemide.

Dear Doctor Le Fanu,

I am 89 years old. In January 2013 I was diagnosed with prostate cancer. I was prescribed 3-monthly injections of Leuprorelin which are proving successful.

Very recently there was an article in the Telegraph about a new drug for prostate cancer which would extend the life of Leuprorelin injections and perhaps even halt the progress of the cancer. I meant to cut the article out but forgot to do it. Can you suggest a way of finding this article and printing it out.

I greatly enjoy your column each week and wish you continued success in the weeks ahead.

Yours sincerely,

Dear Anon,

Thanks for being in touch and it is good to hear these injections are controlling your prostate cancer. I was unable to find any reference to the article you mentioned and to my knowledge there is no adjunctive treatment that prolongs its effects.

Dear Dr James Le Fanu,

I write in connection with the letter from ‘Mr N A from Bath, concerning extreme skin pains.

For the last several months I have suffered these pains: Itching, stinging, burning and stabbing. They started at least a year ago, as painful itching and have developed over time, into the most painful condition. As with Mr N A there is no sign on the skin.

Like Mr N A, I have tried many forms of relief and the only respite I can get, is to apply an Hydrocortisone cream (Betnovate). This mostly relieves but, because the pains are ‘all over’, the cream has to be applied to most of the body.

Unlike Mr N A, I also get the symptoms in the neck and hair.

I have seen two consultants as well as my GP, a dermatologist and a cardiologist (this latter because I have a ‘loop recorder’ implanted and I feared an allergic reaction. I am waiting for this to be removed but, all the doctors doubt this is the cause!).

As the condition is so distressing, I long for a diagnosis.

Yours sincerely, Terry S

Dear Terry S,

Thanks for being in touch and my sympathies for these distressing symptoms which I mentioned in the column last week may be the condition known as Migrating Sensory Neuritis. The cholesterol lowering statins have also been implicated and if you are taking them, a ‘statin holiday’ may bring relief.

Hello,

My dad has severe back pain and also has rheumatoid arthritis and has been on an anti-inflammatory for over 10 years. He recently had a blood clot in his calf muscle and was put on Coumadin.

He was told that he can’t take any anti-inflammatory medicine anymore. Would he be able to take a cox-2 inhibitor or do you know of any other medications he can take to help with the rheumatoid arthritis?

Thank you

Dear Anon,

Thanks for your query. The cox-2 inhibitors, as you suggest are less likely to cause complications in those taking anticoagulants such as Coumarin (see T C Cheetham, ANN Pharmacophore 2009 vol 43 pp1765 – 73). As for the severe back pain this would warrant a visit to an osteopath for manipulation or referral to the pain clinic at the local hospital with a view to an epidural injection. If your father lives in the London area he should contact orthopaedic physician Dr Clifford Harley (07810620058) who is very skilled in dealing with this sort of problem.

Dear James,

You may find the following medical conundrum interesting!

A little background:

Male, aged 69

Good health

Life-long non-meat eater, enjoying a basically Asian/Mediterranean diet.

Minimum of ready-prepared foods in diet

Normal/low blood pressure

No alcohol, tea, coffee or any other stimulants

Low sodium salt intake

Only current medication is Terbinafine for fungal nail infection.

I have developed a sensitivity (ranging from slight to extreme) to a range of foods and food flavourings which previously I tolerated: all produce the same reaction – marked diuretic effects leading to dehydration and lethargy. An unwitting combination of any of the following list can necessitate up to five trips to the bathroom overnight. The problem first arose about 10 years ago whilst living in Rome, affecting me only a couple of times a year. Over the past two years the incidence has risen slowly to more than once a week.

The dehydration can lead to a loss in weight overnight of 1kg from my normal weight of 64kg. My blood pressure falls typically to 99/62 with a pulse rate if 105 after climbing stairs. With either oral rehydration salts, drinking lots of water, and by eating salted peanuts in small quantities, the effects of dehydration normally wear off by early afternoon.

The following list contains the principal observed offending foods/ingredients:

Parsley, particularly flat-leaved variety (admittedly a well-known natural diuretic)

Asparagus (ditto)

Prepared Italian sauces containing “soffritto” herbal flavourings

Parmesan and Pecorino cheeses

Olives in brine with Lactic Acid as preservative

Certain types of Soy sauce

MSG and hydrolysed vegetable protein

Many of these ingredients feature in authentic dishes. Even trace quantities can trigger the sensitivity. There would appear to be some common elements running through the above:

firstly, well-known natural vegetable/herbal diuretics,

and secondly, natural fermentation by-products (dairy and vegetable).

Soy sauce apart, I tolerate most oriental spices very well. However, prepared spices and sauce concentrates do not always list the full ingredients!

I am now into the fifth month of the Terbinafine – is it possible that this is increasing my sensitivity? (I would be reluctant to abandon the anti-fungal treatment, as the response to the long-standing toe nail fungal infection looks promising).

My long-standing GP has recently retired, and locums have not considered my problem to be more than a curiosity. Any thoughts?

Kind regards,

Robert D

Dear Robert D,

Thanks for being in touch and your most interesting (if difficult to explain) account of the diuresis induced by this eclectic selection of foods – and its consequences. This is clearly quite different from the ‘normal’ diuretic properties of coffee and fresh vegetables. I would not have thought that Terbinafine is an exacerbating factor.

Hello

I wonder if you would be able to comment on my problem which is one of what you might call ‘projectile diarrhoea’. I have had this for probably 10 years now. 22 years ago my gall bladder was removed. I think my problem may be connected with that and probably with the possibility that I may not be able to digest fats as I should.

I plucked up courage to mention this to my doctor about 4 or 5 years ago and was referred to a specialist who prescribed codeine tablets up to four a day. As I had no wish to become constipated with the codeine nor to be too drowsy to drive I confine myself to taking Imodium now and again – certainly no more than once a day every few days.

Now to the nitty gritty. I usually have a reasonable bowel motion up to half an hour after breakfast and that’s it for the day. this is fine, but every so often perhaps up to an hour after that I get this very urgent diarrhoea and I MUST find a toilet within a couple of minutes or otherwise I cannot stop it all from coming out wherever I happen to be. I have no way of knowing whether this is going to happen or not so I may be on the morning dog walk and nowhere to go or for instance staying with my daughter and walking the children to school.

I have wondered whether this is bile acid diarrhoea. Because (I think) I don’t ‘go’ like this more than once a day I feel that the doctors are not bothered and therefore I have stopped mentioning it.

I look forward to your response.

Dear Anon,

Thanks for being in touch and my sympathies for the long standing bowel problems which certainly could be due to Bile Acid Diarrhoea though the fact that these episodes only occur in the morning is, as you may know, a well-recognised form of Irritable Bowel Syndrome. It would certainly be sensible to discuss with your doctor a trial of the drug Cholestyramine that, as recently described in this column, can be quite dramatically effective.

Thank you

About nine months ago I read in your column a list of symptoms that fitted the condition I am suffering from – sadly I did not log on to see your reply and as I am still in the same position I wondered if you could trace it for me.

I have a pain that starts in my right buttock goes down the back of my thigh and then transfers to the side of my lower leg and finishes in pins and needles in my foot. Classic sciatica!- sadly this has stayed with me for nine months and is now wearing me down. As I remember the article it was one of your readers writing in with the symptoms and asking if there were fellow sufferers with an answer. Could you please let me know if a magic cure was found or at least the name of this vicious pain. In the beginning it was the sleepless nights that bothered me but now it is the daily pain only kept down with various pain killers.

I do hope that you can find the article and hopefully some magic cure!! Many thanks for a fine column – sadly the older I get the more interesting it becomes! Best wishes

Dear Anon,

Thanks for being in touch. It certainly sounds that you have the classic symptoms of sciatica for which my advice would be the same as that for the query from ‘Anon’ – three above.

Hello, I’m an 83 year old male who has suffered from fairly mild Psoriasis from my late teens. Inherited from my father and passed on, presumably, to my younger son who has it worse than me.

I have sought and tried many possible remedies from my doctor, online etc; Some have given slight relief but none cured it. Happily I have, I believe, cracked it and that is Medi-honey. For just over a week I have washed with Medi-honey body wash and applied, once a day, Medi-honey derma cream.

It is astonishing and almost unbelievable, my skin is now free from red sore patches, flaking and irritation.

I shall continue for the rest of my days of that there is no doubt. Do hope this may help others with this complaint.

Keep up your good work.

David C

Dear David C,

Thanks for being in touch and I am so glad to hear that your psoriasis has responded to the Medi-honey. It is not quite clear why it should have done so but I look forward to mentioning in the column for the benefit of others.

In November our 34 year old daughter approached us asking for help. She told us that she had an alcohol dependency problem and that she thought the only way to deal with it was to go into Rehab.(I have since learnt that her GP had also told her she needed to do this) She told us of a clinic near Cape Town, SA called Stepping Stones. Her work were very supportive and gave her 2 months off. Her extraordinarily generous, kind and understanding aunt paid the fee (very much cheaper than a clinic in the UK and with the ZAR rather low at the moment ….) as we are really not at all well off. There is a history of alcoholism in my husband’s family and, apparently, she had been suffering from depression since schooldays (she was at boarding school) when she was diagnosed and prescribed for depression in the 6th Form.

From a telephone conversation with her counsellor at Stepping Stones I was very much getting the message that ideally my husband and I should go out to Cape Town. Stepping Stones hold a family session once a fortnight and then a family counselling session. My husband has just suffered a stroke and so I was unable to consider going until he was passed fit to drive again. Once he was I flew out but unfortunately he was unable to accompany me due to his health.

At this clinic I attended the family session which, in just a day, tried to explain to us about alcoholism. It was a very intense and informative and I am still trying to process what I learnt. My daughter then told me that not only was her alcoholism very much more serious than we, her family, had realised (suffering black outs etc) but that also, 3 years ago, she had overdosed and been in hospital for 4 days. She had begged her (very supportive network of) friends and her brother not to tell us. Last year she overdosed again on Diclofenac which she had been prescribed for a very badly slipped disc (in old money, sorry not sure of modern terminology). This time, as I understand it, because Diclofenac is not so likely to cause such damage (to liver, kidneys?) she was in hospital for 24 hours.

I simply cannot tell you how very, very angry I am that, presumably because of the data protection act – or whatever – her decision not to allow us to be told (and as she is unmarried we are presumably her next of kin) the first time she overdosed was not over-ruled. From what I learnt at Stepping Stones alcoholism is a mental illness – and she has a history of depression also – and would have been in no state to have made a rational decision. If she had suffered a diabetes hypo say, or had been run over then I am sure we would have been informed. The result of her being denied our help and support at that time has led to a further 3 years of anguish for her as had we been able to intervene and give her the support and help she needed in 2011 we might well have been able to prevent her further and continued decline into alcohol and depression. At the very least we would have been there as a support and help to her. As she is long past childhood, owning her own flat, holding down a responsible job we did not see very much of her sadly. We live in the country and she in London. There was never any rift but because she always seemed to be so busy and social (which she maintains she was although I think some of that social activity was with a bottle on her own in her flat) and we didn’t wish to appear to be “nosey”. We were, of course, sad that she didn’t seem to have a partner or be getting too close to marrying and having a family like most of her friends and didn’t want to appear to be putting any pressure on her in that respect.

On a practical note, although we are not at all well off, happily as I said above another member of the family has paid for her treatment in South Africa. But what about people (the vast majority I suspect) who could not afford to put their child through therapy? How can it be right that a mentally ill person’s family are denied the opportunity to intervene and help? Surely at the very least we should have been offered an interview with the psychiatrist who must have seen our daughter at the time of her first overdose.

I have telephoned MIND to ask them about this conundrum but they were too busy to take my call. I think that we, and other families like us, deserve an explanation as to why we were/are denied the opportunity to help any family member in this situation. Could you offer me some sort of reasonable explanation as to how this can be right which might give me some peace of mind. I am aware that it is necessary for my daughter’s recovery for us also, as her family, to “let go” of any anger and it may be that I am focussing all my anger on this particular point but I cannot emphasise enough how utterly furious I am. Could you advise me to whom I should address this? My MP? He, as it happens, a medical doctor but very young. (Daniel Poulter). Sometimes one can only think that the ‘State’/"Government’ has gone quite mad and all common sense thrown, like the baby, out with the bath water.

Yours very sincerely and with kind regards

Dear Anon,

Thanks for your details account of your daughter’s travails. It is good to hear the facilities in South Africa for sorting out these problems are not only of a high standard but also (relatively) cheap. The specific problem you raise is a difficult one for while sharing this type of information is permitted on a ‘need to know’ basis for health professionals, the patient’s consent is required for relatives like yourself to be informed. Your daughter not only declined to give that consent but also made deliberate efforts to ensure you were not made aware of what had happened. It is obviously clear in retrospect she would have benefitted enormously from your health and support at that time but it is difficult to see on what grounds her doctors could have overruled her decision.

Dear Dr Le Fanu

I am an elderly woman whose hair has suddenly started to fall out in alarming amounts and I hope that you can recommend a suitable remedy.

Thank you

Bettina M

Dear Bettina M,

Thanks for your query and my sympathies for this alarming hair loss without, I presume, any underlying scalp condition. The general recommendation is to wash the hair ‘with care’but the only specific remedy is a regular daily application of the drug Regaine –whose effectiveness is disputed and is not available on the NHS.

I have recently been diagnosed as having a grade1/11 Spondylolisthesis at L4/5 resulting from a fall. I am experiencing discomfort in the lower legs and feet. My consultant has given me the choice of an injection ( a temporary solution) or major back surgery with rods. I feel this is not the route I wish to take at the moment and was interested to read in one of your comments recently of a gentleman with similar problems and you said that this could be resolved by a small incision and micro surgery. Please could you give me information on this. I live in Gloucestershire.

Thank you

Mrs Hazel S

Dear Mrs S,

Thanks for being in touch. I obviously have no specialised knowledge in this field but while there are indeed reports of the benefits of microsurgery for the treatment of Spondylolisthesis I would favour your surgeon’s advice. These operations can be quite tricky and it would seem important to have a full rather than ‘keyhole’ view of what is going on.

Dr Le Fanu"s on-line overall health clinic, Friday 31st January 2014

Today in healthcare: Friday 31 January

Very good morning and welcome to the day-to-day site from the Guardian’s community for healthcare experts, giving a roundup of the crucial news stories across the sector.

If there is a story, report or occasion you’d like to highlight – or you would like to share your ideas on any of the healthcare troubles in the news these days – you can get in touch by leaving a comment under the line or tweeting us at @GdnHealthcare.

The Guardian reviews right now on a report on the state of maternity care by the Commons public accounts committee, which found that the security of pregnant females and their infants in the course of childbirth may possibly be getting place at risk by a lack of NHS funding and a national shortage of 2,300 midwives. Margaret Hodge, who chairs the committee, stated:

There is evidence that a lot of maternity services are operating at a loss, or at greatest breaking even, and that the accessible funding might be insufficient for trusts to employ adequate midwives and consultants to give large top quality, risk-free care.

Even so, NHS England has launched the findings from the first three months of the friends and family members test in maternity care. It reveals that three in four girls say it is “incredibly very likely” they would advise their maternity unit to pals and household.

Today’s other healthcare stories:

• GP on-line: GPs warn of rise in rationing

• HSJ: Alert method will title and shame unsafe suppliers

• Guardian: Rise in hospital admissions for younger individuals with eating ailments

• Independent: Manchester is most ‘inactive’ location in the nation, research finds

• Telegraph: Prince Charles – good food in hospitals ought to be a priority

• Pulse: ‘Be positive’ about 7-day operating, advises extended hrs pioneer

• eHealth Insider: Care.data helpline receives three,500 calls

On the network these days, Kerri Tunstall, a support manager at the Brain Damage Rehabilitation Believe in describes her standard doing work day. She says:

There are difficulties to my work. Each and every services user has unique wants. The key is discovering a stability amongst how we meet all our demands although sustaining an individualised method. We operate with human beings, not numbers or files, and we treat everybody uniquely.

There are difficult concerns facing support customers, their loved ones, families and friends and also our workers. It’s a juggling act to keep it operating smoothly and productively.

Kerri Tunstall’s charity gives rehabilitation, care and help for folks with an acquired brain damage. Photograph: Birt

Elsewhere, Isabel Hardman writes for the Telegraph that Tory modernisers are acquiring their heads round mental overall health, and Andy McKeon blogs for the Nuffield Believe in on clause 118 of the care bill

Kate Granger has blogged for NHS England about compassion in care. She writes:

#hellomynameis was an notion I developed just above five months in the past. I had been admitted to hospital with a severe post-operative infection and a single of my starkest observations was the lack of proper introductions from the healthcare crew hunting right after me. It felt awkward and extremely incorrect. A friendly introduction explaining your function and what you intend to do is the 1st rung on the ladder to creating rapport with a patient, establishing the important trust and therapeutic romantic relationship.

Making use of social media such as Twitter and my private website, I began to motivate healthcare workers to pledge to introduce themselves to every single single patient they met. It is all about inspiring staff to be imaginative and use the concept to carry about a positive culture change inside all care settings.

The response has been overpowering with everybody from porters to pupil nurses to chief executives receiving on board with all method of ideas.

That’s all for these days, we’ll be back on Monday with our digest of the day’s healthcare information.

Today in healthcare: Friday 31 January

Today in healthcare: Thursday 30 January

Excellent morning and welcome to the day-to-day website from the Guardian’s local community for healthcare experts, giving a roundup of the key information stories across the sector.

If there’s a story, report or occasion you’d like to highlight – or you would like to share your thoughts on any of the healthcare problems in the news today – you can get in touch by leaving a comment beneath the line or tweeting us at @GdnHealthcare.

The Guardian reports that 6 hospital trusts are below fresh scrutiny following NHS information uncovered that they had “increased than anticipated” mortality rates. Healthcare correspondent Denis Campbell writes:

Two of the six, Colchester Hospital University NHS basis trust and East Lancashire Hospitals NHS trust, are already in unique measures following NHS medical director Professor Sir Bruce Keogh’s evaluation final year into 14 trusts with apparently high death prices.

Yet another of the six, Blackpool Teaching Hospitals NHS foundation believe in, was also amongst the 14 but was not amid the 11 place into special measures.

The NHS’s Overall health and Social Care Information Centre (HSCIC) on Wednesday explained that people three, plus Mid Cheshire Hospitals NHS foundation trust, Aintree University Hospital NHS basis trust in Liverpool and Wye Valley NHS trust in Herefordshire, all had unusually high death costs in 2012-13, as judged by the summary hospital-level mortality indicator.

Elsewhere, the Independent reports that the Royal Institute of British Architects has located a clear correlation in between the sum of green room, density of housing in urban locations, and the overall overall health of the regional population. Justine Womack, a public overall health specialist at Public Well being England, wrote for the network on a similar theme earlier this month when she referred to as for a “responsibility deal” for the created setting.

In other news right now:

• HSJ: Keep track of interventions double in response to Francis

• Nursing Times: Greater emphasis necessary on mental health of NHS staff

• Independent: A quarter of suicides take place within 90 days of becoming discharged from hospital, examine finds

• BBC: Jabs plea soon after far more measles circumstances

• Guardian: Ban on smoking in vehicles in front of youngsters moves closer right after Lords vote

• Pulse: Patient accessibility to on the web information to be limited to ‘prospective’ data, says minister

• GP On-line: NHS sustainability prepare launched

Creating for the network nowadays, Ben Nunn and Tom Sackville argue that gang violence is a public health problem, and appear at whether or not well being and wellbeing boards are contemplating gang and youth violence in the organizing of local well being solutions. They write:

The expense of violence to the NHS stands at £2.9bn a year (£200m more than the complete public wellness price range that was transferred to regional authorities this year).

In 2010-11, a lot more than 189,000 men and women had been admitted to A&ampE because of violent incidents some hospitals reported that 9% of all emergency admissions were linked to knife incidents.

The government has sought to reply to this challenge. 1 of the central tenets of its reaction to the 2011 disturbances was to move the situation of gang and youth violence away from currently being solely a problem for criminal justice companies, and in the direction of the wider realm of public well being.

Elsewhere, Roy Lilley sets out his six tips to redesign the flow and access to A&ampE
Cristina Odone also looks at emergency care, writing for the Telegraph that bad out of hrs service has spawned a culture of ‘go very first to A&ampE’.

Nigel Edwards blogs for the Nuffield Trust on hospital organisation in Europe. He writes:

… the Uk public sector consists of stand-alone hospitals or reasonably tiny hospital groups in close proximity. France and Germany and to a lesser extent some other nations have big chains or groups of hospitals that have a single management and a typical operating model. Hospitals not part of these groups increasingly have to think about partnering and networking with other hospitals.

All countries recognise that hospitals are not able to be planned as stand-alone institutions, and in numerous EU nations there are regional structures that take obligation for supplying this essential oversight.

… Whilst there is a good deal of rhetoric about building transformative new models of care, in the Uk the strategy is usually just to make the outdated model of hospital provision bigger (and even more away). A amount of the approaches being produced in the rest of Europe challenge some of the assumptions we have about hospitals and there is much more for us to discover.

And Anne Benson writes for the King’s Fund site about what mindfulness has to offer overall health and social care.

That’s all for these days, we’ll be back tomorrow with our digest of the day’s healthcare information.

Today in healthcare: Thursday 30 January

Nowadays in healthcare: Wednesday 29 January

Excellent morning and welcome to the everyday weblog from the Guardian’s neighborhood for healthcare specialists, offering a roundup of the crucial information stories across the sector.

If there is a story, report or occasion you’d like to highlight – or you would like to share your thoughts on any of the healthcare problems in the information nowadays – you can get in touch by leaving a comment beneath the line or tweeting us at @GdnHealthcare.

The Guardian reports that record numbers of folks are getting detained for psychological wellness treatment, prompting concern that conditions for sufferers are worsening due to understaffing and a lack of hospital beds.

There’s also news that the amount of quite elderly people needing to go to hospital by ambulance has risen 81% given that 2009-ten.

Today’s other healthcare headlines:

• Independent: NHS failing in its duty to seem following the wellness of its staff, doctors say
• Telegraph: NHS underneath fire above redundancy payment to overall health chiefs

• Independent: Younger patients with no a GP include to increasing strain on casualty units

• BBC: Ex-Stafford chief nurse ‘struck off’

• Nursing Instances: Care Maker scheme nonetheless short of volunteers as deadline looms
• Pulse: Individuals may get rid of trust in NHS if care.information scheme goes ahead, admits NHS England risk evaluation

Andrew Clegg, a clinical professional at Orion Well being, writes for the network about integrating overall health and social care, saying the way healthcare staff operate with colleagues across different organisations need to alter to accomplish the vision for integration. He adds:

The target on delivering integrated care has so far been on the “challenging” components this kind of as reorganisation, commissioning, overall performance and regulation. In fact Chris Ham, chief executive of the King’s Fund, in a latest weblog about the barriers to integrated care, identified these elements as priorities.

However one essential issue was missing, and that is the attitudes of folks – nurses, GPs, clinicians and management – concerned in delivering care

David Brindle writes for SocietyGuardian about worries in excess of the overall performance of the Nursing and Midwifery Council:

The regulator has been under sustained fire above its efficiency as issues develop about nursing requirements. Its leadership has been replaced and the Department of Wellness has awarded it a £20m grant to fund modifications.

The Commons overall health decide on committee has expressed dismay that a lot more than 400 fitness-to-practise circumstances stay unresolved by the NMC soon after more than two many years. And a high court judge has criticised “disgraceful” and “inexcusable” delays in a case against two nurses that he threw out right after it had been running for more than ten years.

And Mary O’Hara interviews mental health campaigner Charlotte Walker, who writes the award winning Purple Persuasion blog, who says the government’s great intentions on mental overall health are not sufficient:

It is this whole annoying phrase ‘parity of esteem’. Why are we talking about parity – no one is aware of what that implies. We want equality of funding, we want equality of esteem in terms of getting taken significantly, and we want equality of treatment method as in not obtaining to wait for months [for remedy].

Men and women are up in arms when there is a beds crisis in a normal hospital believe in but they are not up in arms [about acute psychological overall health wards]. If you reduce the income then they have to cut companies.

Charlotte Walker’s website, purplepersuasion has gone from private diary to grow to be a valuable campaigning tool. Photograph: Graham Turner for the Guardian

Elsewhere, Michael White writes for the HSJ that accepting obligation when items go incorrect is a single of the elusive concerns of our complicated age on the Conversation website, Eerke Boiten says outdated laws are placing overall health data in jeopardy and the Telegraph’s Benedict Brogan seems at Ukip leader Nigel Farage’s contact to rethink protected places of public spending, including the NHS.

That’s all for nowadays, we’ll be back tomorrow with our digest of the day’s healthcare information.

Nowadays in healthcare: Wednesday 29 January

Nowadays in healthcare: Tuesday 28 January

Good morning and welcome to the every day website from the Guardian’s community for healthcare professionals, offering a roundup of the important news stories across the sector.

If there is a story, report or event you’d like to highlight – or you would like to share your ideas on any of the healthcare concerns in the news today – you can get in touch by leaving a comment under the line or tweeting us at @GdnHealthcare.

Reporting for the network, Paul Dinsdale reveals that about 300 NHS staff in commissioning assistance units are dealing with redundancy in the initial wave of management job cuts considering that last April’s reorganisation.

There’s also news that a simple mix-up in an operating theatre that left a  10-yr-old girl with catastrophic brain harm has led to the NHS facing a £24m payout – the greatest in a situation of medical negligence. 

Elsewhere today:

• Telegraph: Anger in excess of NHS ‘U-turn’ on prostate cancer medication

• HSJ: Trusts face new emergency division regular

• eHealth Insider: Care.data safeguards detailed

• Nursing Times: Staffing gap grows between NHS nursing sectors

• GP Online: Patients at threat as flu vaccine uptake drops to three-12 months lower

• BBC: New calls to alter intercourse and relationship education

Dr Chris Lancelot writes for GP Online calling for NHS England to deal with excessive demand and as well number of sources. Responding to information that NHS England is £225m overspent, he writes: 

Bad factors! They are overloaded and have also several responsibilities. My heart bleeds for them. NHS England has just received a taste of its personal medication – and guess what? — it’s caved in instantly.

Sadly, it soon recovered and — at a time when GPs are functioning twelve-hour days and with every single likelihood that the acute solutions will turn out to be swamped — quickly launched a campaign to get individuals to seek skilled aid early to keep away from the dangers of late diagnosis.

So allow me get this straight: NHS England overspends hugely, but nonetheless cannot do its task since of excessive demand nevertheless it still expects GPs to cope with lowering assets and excessive demand which it makes a stage of attempting to boost.

How can we believe in NHS England when it behaves like this?

Guardian columnist Michele Hanson writes, following a friend’s current knowledge, that NHS hospitals are over-run with rules and laws.

And on  the Health Basis blog, Jeremy Taylor, chief executive of National Voices, says patients should define worth. Following a presentation by  Harvard professor and enterprise guru Michael Porter at a conference final week, Taylor writes that individuals “can not only define worth but produce worth – if provided the chance”.

That’s all for these days, we’ll be back tomorrow with our digest of the day’s healthcare news.

Nowadays in healthcare: Tuesday 28 January

Right now in healthcare: Monday 27 January

Great morning and welcome to the everyday weblog from the Guardian’s local community for healthcare experts, offering a roundup of the important information stories across the sector.

If there’s a story, report or occasion you’d like to highlight – or you would like to share your ideas on any of the healthcare issues in the information these days – you can get in touch by leaving a comment beneath the line or tweeting us at @GdnHealthcare.

Figures obtained by the Guardian have proven the most full image however of the reliance by the NHS and local community health providers in England on foreign nationals, with folks from far more than 200 nations employed. The statistics, created by the Health and Social Care Data Centre, display 11% of all personnel for whom information was obtainable and who work for the NHS and in community health companies are not British. The proportion of foreign nationals increases for professionally certified clinical employees (14%) and even far more so for medical doctors (26%). Tim Finch, from the Institute for Public Policy Study thinktank, explained the statistics held lessons for immigration policy:

People are nonetheless attracted to operate in the NHS. With out them we would clearly be quick – it would be quite difficult to change that number overnight. If the single thread of immigration policy is just to get the overall figure down by any implies, you have got to look at the consequences of that on the NHS.

In other news these days:

• Telegraph: Warnings more than shortages of intensive care beds

• BBC: Survey of cancer individuals – 89% say therapy outstanding or very great

• Independent: It is time to get severe about NHS, says comedian Rufus Hound

Comedian Rufus Hound is organizing to run for the European parliament as a candidate for the National Health Action celebration. Photograph: Dan Kitwood/Getty Pictures

Weekend headlines

Hospitals are dealing with increasing “bed blocking” as they attempt to deal with an improve in the variety of patients needing to be admitted as emergencies this winter, the Guardian reported.

And Prof David Haslam, chairman of the National Institute of Overall health and Care Excellence, called for British individuals to adopt much more “pushy” American attitudes with their physicians to get medicines they are entitled to.

A lot more healthcare stories from the weekend:

• Guardian: Watchdog rejects ‘societal benefit’ check on NHS medicines

• Observer: Psychological wellness care: where did all it go so wrong?

• Telegraph: £100,000-a-yr GPs quadruple in a decade

• Independent: Consuming issues soar between teenagers – and social media is to blame

• Mirror: Hungry households begging their physicians to create notes for meals vouchers

• Pulse: NHS England steps in to support practices struggling to recruit GPs

• eHealth Insider: Hull creates actual-time A&ampE waits app

Comment and evaluation

On the network today, Roger Taylor, co-founder and director of analysis at Dr Foster Intelligence, writes about the care.information venture, arguing that the advantages of NHS information sharing outweigh any possible dangers. He writes:

An vital portion of ensuring that folks are cozy with this kind of methods is offering them a lot more handle. Allowing individuals to opt out of the scheme is essential. But absolutely everyone who opts out, weakens the capacity of the NHS to manage care successfully. This is the least desirable final result.

Equally crucial is providing folks better manage in excess of the underlying data. Permitting them to see the details, correct it and use it themselves if they want. That is crucial if we are to do well in encouraging men and women to allow their data to be utilised to develop expertise that will advantage all.

The care.information database was also the topic of a column for the Observer by John Naughton, who asked whether or not the government had learned practically nothing from the privacy debate.

And on the Wellness Foundation weblog, Kallur Suresh looks at the “total suite of data that healthcare companies have to acquire frequently”. He writes:

No 1 can deny that measuring what we do and how we do it is important. It is a scientific reality that optimal functionality can’t be attained if we do not know how we’re carrying out. However, currently being forced to measure the same issues, no matter whether they are appropriate to the nearby context or not, is what gets to be aggravating. I’ve frequently heard folks comment that we’re ‘hitting the targets but missing the point’.

Suresh,  a Wellness Basis GenerationQ fellow and a advisor psychiatrist for older individuals in Essex, goes on to make some recommendations:

Let freedom for neighborhood teams and organisations to define what requirements to be measured in their nearby context, in consultation with individuals and carers. This will make them far more engaged, enthused and give them a sense of management in excess of their destiny. Significantly decreasing the amount of necessary targets to just a handful is a good way of empowering neighborhood suppliers and clinicians, in conversation with patients and carers, to come up with much more meaningful quality and outcome measures.

That is all for these days, we’ll be back tomorrow with our digest of the day’s healthcare information.

Right now in healthcare: Monday 27 January

NHS need to charge patients, say McKinsey consultants: from the archive, 24 January 1977

A important principal on which the NHS was created in 1948 was that companies would be cost-free at the stage of use. Photograph: SSPL/Getty Pictures

The management consultants who helped to layout the new structure of the Nationwide Overall health Services in 1974 say that the scheme has failed and should be scrapped.

They also propose scrapping the tradition of a totally free well being service and introducing £20 a week “hotel” fees for hospital stays, a £5 bill for every visit to a hospital casualty division and a £2 fee for each and every go to to a GP. The partners of the McKinsey management consultancy also advocate, in their proof to the Royal Commission on the NHS, scrapping two of the current tiers of administration, getting rid of most managerial obligation from the Division of Well being and Social Protection and creating an NHS commission to run the services.

The McKinsey evidence, which has but to be formally published, condemns the new NHS construction of location and regional health authorities for major to a “proliferation of paper” and a “substantial bureaucratic dilemma.”

The total NHS is in crisis, with troubles of morale, staff grievances, soaring costs, a dissatisfied public, small extended-phrase planning and so on, the McKinsey evidence says.

The McKinsey argument is a mixture of controversy and consensus. A lot of of these offering evidence to the Royal Commission are confidently expected to attack the 1974 construction of “tiers of authority.” The Society of Civil and Public Servants, representing individuals DHSS administrators who have oversight of the NHS, announced yesterday that they desired the regional well being authorities to be abolished.

The Labour Get together in opposition attacked the 1974 reorganisation scheme, and the two Labour Secretaries, Mrs Barbara Castle and Mr David Ennals, have made it plain that they are less than enthusiastic about it – but that it would be even much more unsafe to tinker yet again with a technique that is still recovering from its final overhaul.

The opposition social services spokesman, Mr Patrick Jenkins, said last night that the 1974 structure had turned out to be “somewhat a lot more cumbersome” than Sir Keith Joseph had envisaged, and surely far more than McKinsey had suggested.

The McKinsey proposals on charging for wellness amenities are very likely to be the most controversial. The British Health-related Association is thought to be nearly particular to suggest “hotel” expenses for hospital stays, but it has set its encounter against separate charges for each and every consultation of a GP. The McKinsey suggestion of an NHS commission also has its echoes amongst some aspects in the BMA, who have named for a BBC-variety public overall health corporation to “take politics out of medicine.” The BMA’s ultimate view will not be known until right after a special BMA meeting in March.

NHS need to charge patients, say McKinsey consultants: from the archive, 24 January 1977

Dr Le Fanu"s on the web well being clinic, Friday 24th January 2014

Dear Doctor James

I have been having this problem since last September, that is, I suffer badly with itchiness and sometimes accompanied by discharge and the feeling of not being able to pass urine. I feel as if I want to pass water, but sometimes there is nothing there, or when there is at the end of it is quite painful.

I was given so far 4 course of different antibiotics and I have also used 12 Canesten pessaries and 3 tubes of Canesten Cream. I am also using the HRT Vagifem. Nothing has worked so far. It has been hell, particularly for the past 2 weeks, I haven’t been one day free of this terrible itchiness.

I feel I would like to find out the reason why the problem goes away, but keep on returning again and again.

My GP keeps on doing urine test which have showed to have an infection, hence all the different types of antibiotics I have taken so far, but it does not work.

What could you recommend as I don’t know what else to take to alleviate this problem? It is so uncomfortable and distressing.

Kindest Regards

Yours sincerely

Maria

Dear Maria,

Thank you for being in touch and my sympathies for the distressing condition you describe. My impression would be that this due to a combination of factors where the Atrophic Vaginitis and the chronic vaginal thrush has resulted (I presume) in inflammation/infection around the urethra which then tracks up to the bladder resulting in cystitis. The situation is further complicated by the antibiotics taken for the cystitis predisposing to the vaginal thrush causing a sort of vicious circle. It might be sensitivity to either the pessaries or the Vagifem may be compounding matters. I would suggest discussing with your doctor switching from the Vagifem to oral hormone replacement therapy which together with the antifungal drug Diflucan should control the vaginal thrush. It can also help to take a longer course of antibiotics (for a month) to ‘sterilise’ the bladder and prevent recurrence of the cystitis.

Glucosamine “holiday”

Dear Dr Le Fanu

With reference to “feeling much fitter after discontinuing Glucosamine tablets”, I’m curious to know what type of Glucosamine these people were taking. High dose Glucosamine Sulphate introduces a lot of Sulphates into the body and doesn’t do your bones much good. (No one with Osteoporosis should take the Sulphate version). Glucosamine Hydrochloride is a much safer version in that respect supplying a much higher percentage of actual Glucosamine which as you know is used in practically every cell in the body. Can you please find out for me which version they were taking.

(Information taken from Dr Paul Clayton’s book Health Defence)

Kind regards

Patrick C

Dear Patrick C,

Thanks for drawing attention to these two formulations of glucosamine. They are, I gather, claimed to be similarly effective – but it could be that those who have benefitted from discontinuing them were, as you suggest, taking the sulphate form. I will mention this in the column.

Osteoarthritis and osteopenia

Dear Dr Le Fanu,

I feel to be in a Catch 22 situation: having seemingly inherited a back condition and having issues as young as !7 with back and knees, and repeated prolonged episodes of pain throughout life, I was recently diagnosed as being moderately hyper mobile. My lifetime ( 72 years) of misuse flashed before me! Always interested in self help I sought the remedy in extreme yoga, ballet and other energetic forms of dance. At the same time as the repeated over? stretching, I have been passionate about hill walking, fast fitness classes and cycling. I am now told that I am doing too much weight bearing exercise which could cause further wear and tear on the right hip (it is not too bad as yet) whilst I had been counting on this for preventing osteoporosis. I take plentiful fish oil, Algaecal and use many herbs and spices. Other supplements I take intermittently. I have only just started on Rosehip extract said to prevent destruction of cartilage. Most of the above forms of exercise I have been forced to give up. I will not give up the walking as I need what little VitD is available (it is in the Algaecal also) and it is my form of antidepressant. Indoor cycling or crosstrainer indoors would depress me. Swimming O.K. My swimming pool not ideal. Have you any experience of Power Plate? I feel that this would be a short sharp session, minimising that couped up feeling. Or any other suggestions for appropriate exercise? I find the Alexander Technique brilliant, but cannot always afford to indulge.

Gratefully, Mary C

Dear Mary C,

Thanks for being in touch. You must be badly affected by your back pain to have to give up these outdoor pursuits that have kept you healthy for so long. I am sure you would benefit from a visit to the pain clinic at your local hospital with a view to a pain killing injection into the facet joint of the spine or something similar. Beyond that I don’t have any suggestions about ‘appropriate‘ exercise but would have thought that a physiotherapist or experienced trainer would be able to advise you further.

ALAMY

Dr Le Fanu,

I am aged 60 and several years ago suffered a vitreous humor detachment in my left eye. The right eye went the same way less than a year later leaving me with a large amount of “floaters” directly in my visual field.

I understand they are not in themselves harmless although one has to be cautious of complications involving possible retina detachment later in life.

The biggest problem is that, although I was told these floaters will generally disperse out of the field of vision in time, there is no sign of this happening.

I cannot emphasise how extreme they are – I liken it to seeing everything through a pond full of tadpoles and it has sadly affected my ability to enjoy reading – I have to constantly flick my eyes to move the floaters to enable me to read a few words before they drift back into view, effectively obscuring the words on the page.

I understand there is an operation involving removal of the gel in the eye but I have heard of many instances reporting a poor outcome.

I wondered if you have any comment that could give me hope I might improve my ability to read properly!

Many thanks

Peter G

Dear Peter G,

Thanks for being in touch and my sympathies for this serious floater problem. This is a difficult situation because, as your will know, there is no treatment other than surgical removal which is not widely practiced and described as ‘risky’. Nonetheless I would have thought it appropriate to discuss with your doctor referral to a specialist in treating vitreous problems in the eye – perhaps at Moorfields Hospital – for an opinion as to whether this might be an option in your case.

Dear Dr James

Regarding the lady with ear pain. You do not mention whether she sleeps on feather or foam/fibre pillows. I always travel with a small feather pillow as I get what I call “hot ear”- painful ears, when I sleep on artificial filled pillows. One of my daughters is the same, though she has had to get used to, and cope with the problem as her husband is allergic to feathers!

Sincerely

Valerie T

Dear Valerie T,

Thanks for that useful hint and I will mention in next week’s column (3rd Feb).

Dr James,

Regarding the lady who has had to sleep on her back for 20 years due to pain when her ears contact the pillow, I have seen pillows marketed in Canada and the United States which have a void in the middle to enable the ear not to touch the pillow surface. I believe they are available through various suppliers online.

I used to have a problem with pain in my right ear which prevented me from sleeping on my right side for several months. I believe the problem was caused by my excessive movement during the night which resulted in my ear unknowingly becoming folded back. Since I have stopped drinking caffeine in the evenings, and have reduced my alcohol intake which was not particularly excessive, I have had no recurrences for over a year.

Hope this may be of some interest to your correspondent.

Regards,

John F

Dear John F,

Thanks for those useful comments and see above.

Dear Dr. Le Fanu,

With reference to Mrs. D’s “very itchy area around my anus”, I was reminded of the same problem that my son had many years ago – in his case, however, it was caused by enterobiasis (oxyuriasis), which is a possibility that she might consider.

With kind regards (and my thanks for your ever-interesting column),

Ian G

Dear Ian G,

Thanks for that important reminder that worms can be an eminently treatable cause of itchy bottom.

Dear Dr Le Fanu,

I read with huge interest your article ref Mr. NA from Bath.

I have a life long friend who at the age of 81 has been suffering serious discomfort with a skin problem for many years. The last two he has been under a specialist and all sorts of topical and oral avenues have been tried, all being unsuccessful. He has constant irritation resulting in bleeding both at night and during the day to the extent that he has become housebound as is embarrassed in company.

I would be most interested to hear the feedback from your article and will you please advise me how I can arrange that.

Your articles are always interesting and informative and I am sure you give huge comfort to many.

All good wishes and I hope to hear from you.

Anne Q

Dear Anne Q,

Thanks for being in touch and my great sympathies for your friend’s misfortune. There are, as you know, a lengthy list of causes of itchiness in your friend’s age group which presumably the skin specialist has considered. Still it is a bit surprising that none of the several treatments he has tried have been of value and I wonder if this may have included a course of steroids that can sometimes work quite dramatically. The further possibility readily overlooked is that the itchiness can be a side effect of commonly prescribed drugs such as statins.

Dear Dr

In the last few weeks I seem to have developed a strange signal of a need to open my bowels.

I have had a difficult relationship with my bowels for many years on and off, I take 2 Senna tablets on prescription every night. If I try to “go” when not quite ready it usually ends in a struggle.

Recently I have noticed a strange feeling down the back of my left hand on the left side towards my little finger, It’s not painful just enough to catch my attention, I respond by going to the lavatory successfully.

At first I thought it was my imagination but it happens daily. I would be interested to know if this is common. Presumably other people experience this, but it’s not talked about.

Regards

Jan B

Dear Jan B,

Thanks for being in touch and your account of this unusual (and fascinating) symptom that I have encountered before associated with urination – but not with the bowels! The suggested explanation is that this is due to pressure on the nerves in the neck from the position adopted when sitting on the toilet – leaning forward with elbows on knees and then looking upwards. This should improve with a visit to the osteopath for some gentle manipulation of the neck.

ALAMY

Dear Dr. Le Fanu,

I have had several episodes of Ocular migraine in the last month. (About 8). No accompanying migraine, and no other symptoms. I consulted an Ophthalmic Surgeon, who said my eyes were fine, and that the cause of Ocular Migraine is not currently understood. He said – that he also had them! My GP send me off for various blood tests, and the cholesterol count was 7.2. I am nearly 69 yrs old, take no meds, and I am fit. BP 130/78. This is elevated, as my BP is usually 120/70 I am 5′ 3.5″ tall, and 1 stone heavier than usual, at 10 stone.

My questions to you are:

1) Is Ocular Migraine a vascular disease?

2) Am I at a significantly higher risk of a stroke?

3) What is the best preventative action that I can take? (Pref without meds)

Many thanks

Dear Anon,

Thanks for being in touch. Ocular migraine is indeed vascular being caused by spasm of the blood vessels to the retina at the back of the eye. It does not, to my knowledge, increase the risk of stroke. The cause, as your GP notes, is not known but it can be triggered by stress, exercise and bending over though not (or rarely) by caffeine, alcohol and other foods that may be implicated in the classic forms of migraine. I would have thought that were these episodes to become more frequent (and eight in a single month is quite a lot) you should discuss with your doctor taking some simple preventive medication such as aspirin or Atenolol.

ALAMY

An itchy embarrassing subject

Dear Dr Le Fanu

Thank you for your answer in the confidential health clinic. Your answer is very interesting, because in the week since I wrote to you an interesting thing has happened. I remembered that when the itchy problem was very bad before, I was trying to lose a few pounds in weight, as I am at the moment. I always eat lots of fruit, but more so if I’m on a diet, eating 1-3 satsumas daily. To put this theory to the test, this week I have stopped eating any citrus fruit, and the itching is greatly improved, to the extent that I’ve stopped using any cream. So your reply was very interesting, especially the comments about food and drink that might have a role to play. Why would this be – is there a scientific reason, or is it just an observation?

Thank you so much for your answer – just writing to you made me realize how miserable the condition is, and spurred me to think of a possible cause myself. As it turns out, it wasn’t such an unlikely idea after all! I shall avoid the satsumas and let you know if my relief is temporary or permanent.

Many thanks

Mrs D

Dear Mrs D,

Thanks for that follow up and how interesting to learn that satsumas seem to be the culprit in your case.

Hello

My wife,aged 85 has over the past year, developed the irritating problem of getting an attack of hiccups after eating something sweet particularly at meal times. The attacks can last up to 10 minutes. Can any of your readers suggest a way to avoid this happening.

D A C

Dear D A C,

Thanks for your query on your wife’s behalf. Some foods and drinks can indeed bring on the hiccups particularly the hot and spicy, carbonated drinks and alcohol. It is however difficult to see why ‘something sweet’ might be responsible – especially, as you probably know, one of the many cures include taking a spoonful of sugar!

Dear Dr James

I have been having an HRT implant since I had a full hysterectomy in 1986. I am now 73 and although I have the lowest level 25 (g?) once a year I have been told that it can cause strokes in the over 70s. I have CLL and am not on any medication and wonder if the HRT is contributing to my good fortune in this respect. I am in a real quandary as I now feel my energy levels are becoming depleted. Do you have an opinion on this subject?

Mrs L

Dear Mrs L,

Thanks for being in touch. The Medicines Adverse Research Committee has advised there is a small increased risk of stroke associated with HRT and perhaps it might be sensible having taken it for 25 years to consider discontinuing it. It is, of course, important to ensure there is not some other treatable cause of these low energy levels such as anaemia (perhaps associated with the CLL) or an underactive thyroid.

Dear Dr Le Fanu,

Much attention, rightly, is given to failing sight and hearing, but I (aged 64) suffer from another and, as far as I can tell, scarcely noticed failing.

Whilst both parents and my sister had/have normal perception of smell, and my wife has a very acute one, my nose has always been less sensitive. Neither is it entirely satisfactory as a breathing channel due to its narrowness and consequent tendency to act as a self-closing valve. My sense of taste may not be the finest but it has worked perfectly well, and continues to do so.

I have long suffered from fairly mild chronic catarrh, which my GP has suggested may be caused by urban air pollution or by dairy products, which I tried giving up for 3 months with no improvement.

However, in recent years my sense of smell has declined markedly and it requires quite a strong odour for me to be aware of it. Whilst this is hardly a life-threatening condition, I suppose I could fail to smell the smoke if the house caught fire. I have mentioned this to my GP who was not interested, and have tried to research my condition via the internet, but there seems very little research or advice on the subject of either hyposmia, which is where I think I am, or anosmia, which is where it seems I am going.

Any assistance or information that you might be able to point me to would be very welcome.

James M

Dear James M,

Thanks for being in touch. I would have thought your reduced sense of smell (Hyposmia) is probably due to the nasal problems you describe that are strongly suggestive of chronic Rhinosinusitis. There is impressive evidence that this responds to prolonged treatment (three months) with antibiotics such as Clarithromycin (see Anders Cervin, Rhinology 2007, vol 45, pp 259-67 that can be downloaded from the internet) You should discuss this with your doctor. I would be more than interested to learn whether this does improve matters.

Dear Dr. James,

I was interested to read your piece about glucosamine and how some people find it actually makes their joints stiffer and more painful.

I am 76 years old, female and was diagnosed with osteo in the knees 30 years ago. I exercise a lot. About 10 years ago I began to take glucosamine and rarely have pain unless I walk a long distance. If I do get twinges, I stop for a while.I do not need any pain relief. I am convinced that the glucosamine has held off the deterioration, though of course, it is difficult to be sure about this.

I find your column really interesting and informative.

Many thanks,

Dear Anon,

Thanks for those interesting comments. It is good to hear you are not too much troubled by the arthritis of the knees – though as you say, it is difficult to know whether this is due to the glucosamine!

Hello Dr Le Fanu

My husband (who’s a dentist) wakes every few weeks with marks on his forehead, as in the attached photo. There’s usually just one (hence my decision to ask you for ideas!), slap bang in the middle above his nose.

He keeps his nails short and smooth so can’t see how it could be scratches (and the marks don’t look like scratches); he’s not aware of any discomfort or skin irritation in that area in the morning.

No obvious irritants in the bed or pillows….we have no explanation!

Do you have any suggestions, please?

Thank you

Billy-Anne

Dear Billy-Anne,

Thanks for being in touch and the photograph of your husband’s red patch on the forehead. This is of particular interest as I too have had this intermittently over the years. It certainly looks as if it is due to bleeding from the small blood vessel under the skin – but why it should occur and in just the one place I have no idea!

Dear Dr Le Fanu

I am a 74 year old woman and would like your opinion of my problem.

It started 3 years ago when I was woken in the night with pain in my jaw and teeth. My pulse was racing ,and this lasted for about an hour with no after effects.

This used to happen at long intervals – 2-3 months , and was always in the night .

I was seen by a cardiologist who did not give me a diagnosis and said I would need to be seen while having an attack. I did go to hospital once , but by the time I was monitored the attack had passed.

In 2013 it only happened once , in January and I thought it had stopped , until January this year. The pain in my neck and teeth was the same but my heart rate was irregular and fast.This time it lasted for 6 hours. Just over a week later it happened again , this time about 4 hours.

I would like to know what causes this and whether it is likely to get worse..

Yours faithfully

Dear Anon,

Thanks for your query. These episodes of palpitations certainly sound as if they are due to the disturbance of heart rhythm known as Paroxysmal Supraventricular Tachycardia. It is possible that the pain in the neck and teeth is angina as the rapid heart rate increases the heart muscle’s need for oxygen. These episodes can be terminated by vigorously massaging the artery in the side of the neck just beneath the jaw line – known as Carotid Sinus Massage. I would have thought that with the two recent longish episodes within a fortnight you should really discuss with your doctor being referred back to the cardiologist.

Dear Dr Le Fanu,

I have a milder problem than Mrs HN from Reading as it is only my right ear that is affected. It is nevertheless painful. I also have a problem with that ear if I am out in the cold and wet as the ear flap and area below are extremely sensitive to even a light touch. My Doctor has no explanation. Do hope your readers will come up with some suggestions.

Yours faithfully

Celia T

Dear Celia T,

Thanks for your comments. See Valerie T above.

So the dilemma of golf and diabetes rumbles on in a very lighthearted way by the sounds of things but in fact one can be put in a very serious situation, not just because of the havoc of these blood sugar swings, but one’s playing partners can be quite alarmed by the rather bizarre golfing actions that can take place.

I regularly go to the gym with no problems whatsoever and when younger played squash on a regular basis at a competitive level but for some reason golf seems so much more difficult and to be quite honest I’ve yet to speak to a doctor, diabetic nurse or dietician who understands the situation, probably partly because they don’t play golf and are totally unaware of what actually is involved in playing the game. We see the game on television and all the professionals are strolling along the fairway looking relaxed – well no wonder they have a caddy and are looked after hand and foot.

In all the years I’ve been diabetic not one doctor has come up with a sensible suggestion. Tomorrow I’ll be playing just after nine and due to the course conditions will be carrying my clubs so I’ll have to be extra careful.

Regards

Denise W (frustrated golfer)

Dear Denise W,

Thanks for being in touch and I quite appreciate why, as you say, enthusiastic golfers like yourself should find this exacerbation of their diabetes so frustrating. It must somehow be related to the nature of the exercise involved in the sport but precisely what is not clear.

Dear Dr. Le Fanu,

My partner had an operation on his left ear, and because of a neck complaint, he cannot lie on his right side.

He found a piece of pillow sized sorbo rubber, and cut a large hole in the middle, and covered it with muslin.

He hopes this might help Mrs. HN from Reading.

Yours sincerely,

Deirdre L

Dear Deirdre L,

Thanks for your comments see Valerie T above.

Re Mrs. HN from Reading.

Dear Dr. Le Fanu,

I had similar symptoms to Mrs. HN for 25 years from the age of 14years. They were cured by visits to an Osteopath who treated me for a partially dislocated jaw and by cranial osteopathy.

The cause was thought to be either an earlier blow on the head or, more likely, the forcing open of my jaw during removal of my tonsils about 18 months before onset of severe symptoms.

Hope this helps. Regards, MT

Dear MT,

Thanks for your comments see Valerie T above

Re the problem of the lady from Reading.

I also have this problem and have to make a hole in my pillow to protect my ear before sleeping on either side.

There are pillows which have a triangular piece removed so you can support the head with the ear in the space.

I know not where you can buy these, but I am sure Amazon will provide!

Regards,

B. G

Dear B G,

Thanks for your comments see Valerie T above.

Dear Dr Le Fanu,

I am a 67 year old male with the following statistics: BMI 26.0, Ht 1.85m, Wt 89kg, BFI 17, Blood Pressure 135/75 average, Cholesterol TC 5.0 & LDL 1.25. I am a non-smoker. My BMI is slightly high but I believe my Body Fat Index (BFI) balances this out.

I have been regularly active for over six years with the following weekly activities: Half hour aerobics, two half hour general gym exercises/running, hour and a half badminton, half hour volleyball, golf.

I have varying degrees of Tinnitus in my right ear, which at present is hardly noticeable. This started in 1999 for which I had a brain scan (MRI). The result was that nothing could be identified to indicate any defect. In January 2012 I had a severe bout of echoing in my right ear for about a week. When this subsided my hearing was noticeable reduced in this ear. I did not go to a GP at this time as I needed to go to New Zealand! When I returned I saw the GP and had tests on the ear and the hearing loss was confirmed but not enough for a hearing aid as my left ear was strong enough to take over. (Prior to 1999 I had three infections in my right ear which occurred after flying to other countries and swimming straight away). I was referred by my GP for an MRI scan without contrast on the 15th August 2012. The report for this scan stated “It showed a focal area of abnormality in the left midbrain measuring 4 mm and they thought it was benign in nature”.

I had another scan with contrast on the 20th February 2013. The following Consultant’s report stated “He has had no previous symptoms of stroke. MRI scan of brain again shows a 4 mm well defined area of brain loss in the left midbrain. There is no surrounding oedema or contrast enhancement. Overall there does not appear to be any significant neurological condition, in particular the change in the scan is not an expanding lesion. Probably this is a small stroke experienced at some time, for which management includes general measures including management of any hypertension and not smoking”.

I met with my GP on the 13th May and it was recommended that I take Statins based on the Cholesterol readings above. My ratio is 4.0 and my GP wanted to have it as 2.0. I asked whether I could try and bring it down to change the GP’s mind. I had another Cholesterol test in November 2013. My GP’s notes (via the receptionist) state “results are slightly lower – recommend Statins”. I have an appointment with my GP in two weeks time.

My questions are: Could a 4 mm area of brain loss be caused by anything other than a stroke? If I have had a minor stroke prior to August 2012 would it be a low probability for another stroke to occur. I have heard that if there is no treatment after a mini stroke that another stroke would normally soon follow?

My annual travel insurance is due for renewal and with my screening questions I mentioned the “probable stroke” and that at present my GP recommends Statins, which I decided not to take. They would not insure me and I assume other companies would be the same. If my GP keeps that recommendation on file I assume I have no option but to take Statins!

A bit long winded but this is my last bid in trying to not take Statins unless really necessary.

Yours sincerely

Dear Anon,

Thanks for your challenging query. We have to presume that the first MRI scan in 1999 was correctly reported as being normal – in which case the ‘benign’ area of abnormality on the subsequent scan must be presumed to be a ‘vascular event’ such as a stroke. This might, I suppose, have caused the episode of echoing and loss of hearing in January 2012 (though I would not be certain of this).

You obviously have none of the risk factors for a stroke but it might be that a daily low dose aspirin might reduce the risk of having another. As for the cholesterol levels they would not warrant lowering but statins, like aspirin, have a blood thinning (or fibrinolytic) effect and this would be a reason for prescribing them in your case. I would have thought in view of the difficulties you are having in obtaining travel insurance the sensible compromise might be to take 10mg Atorvastatin (that is least likely to cause side effects).

Dear Dr. Le Fanu,

Thank you so much for your interesting and informative column.

I have been taking 500 mg Glucosamine Sulphate daily for about eight years. My osteopath suggested that it might help with lower back problems.

Now 65 years old, I did for the past 6-9 month have severe stiffness and cramps in both legs, to the extent that I sometimes had to hold onto the furniture to walk around.

When I read about Glucosamine in your column in December, I stopped taking it immediately. Within a few days I was much improved, and now, six weeks later, it is clear that the Glucosamine was causing all the problems. I can now go for a 2 mile walk again with ease.

My query is: why did it take years before these problems occurred?

Thank goodness you included the discussion in your column.

Many thanks

Best wishes,

Mrs Jo G

Dear Mrs Jo G,

Thanks for your interesting account of your glucosamine experience – and I am, of course, delighted to hear you have benefitted so much from reading something in the column!

Dear Doctor James

For the past 6 months I have had 5 urine tests and in four of them it showed I had an infection (white cells). It is quite painful when passing water, and it is accompanied by a very itch vagina.

My GP keeps on prescribing antibiotics, but it goes away and within 2 weeks it returns again. I was just given yet my fourth course this morning of Macrodantin antibiotics, the after that 1 capsule Fluconazole.

Can you advised what is the way to put an end to this suffering as it is so unconformable.

Many Thanks

Mrs N

Dear Mrs N,

Thanks for your query and my sympathies for this problem which is not dissimilar to that of Maria (see above) though I presume you do not have the complicating factor of menopause induced Atrophic Vaginitis. It is not clear why you should be having these recurrent episodes of cystitis – but it would be sensible to discuss with your doctor ‘sterilising’ the bladder with a month long course of antibiotics. This would, of course, exacerbate the vaginal thrush so you need to take a couple of doses of Diflucan weekly to keep this under control.

Dear Dr

My friend was hospitalised with chest pains he spent 10 days in hospital while in hospital he had an angiogram. When he left the hospital he was put on a repeat prescription of Aspirin, Atenolol, Clopidogrel, Isosorbide and last of all Simvastatins, he was on the statins for app 18mths then he was taken off the statins.abruptly. The family now know that statins can have some very serious side effects including (Hepatic) would this include HepC and B?

John

Dear John,

Thanks for being in touch. I presume the doctor has discontinued your friend’s statins because they were causing inflammation of the liver – which should now improve. This is quite different from Hepatitis B and C which are viral infections of the liver.

Dear Dr. Le Fanu : Can you help me regarding my recent diagnosis of lymphoedematous rosacea of the bottom portion of my nose – I don’t know what the best treatment options are ? a) I get up every day with a swollen nose since mid-july 2012 ; b) there is also enlargement of tissue on the tip of the nose – I feel as if I’m turning into a proboscis monkey ! c) pores on nose are very enlarged – like orange peel. The NHS say they can do no more for me , prescribing doxycycline – good for the skin problems – but does nothing for the nose ! It’s a very depressing state of affairs as I am now socially withdrawn. I find this condition very distressing so I look forward to your advice. Yours sincerely Pat H

Dear Pat H,

Thanks for being in touch and my great sympathies for this disfiguring enlargement of the tip of the nose which I presume is what is known as a Rhinophyma. There are several techniques for improving the appearance including carbon dioxide laser and surgical shave. You should discuss this further with your doctor.

Dear D Le Fanu.

With reference to Mrs HN from Reading who can only sleep on her back because of pain in her ear.

Could it be a blocked eustachian tube which l have had and is very painful . It is cleared by holding the nose and blowing . This has helped me. Cate G

Dear Cate G,

Thanks for your comments see Valerie T above.

ALAMY

AUG. ’12 Patient discharged from hospital with note to G.P. to follow-up management of high blood glucose level.

Patient/family not informed that Type2 Diabetes Mellitus had been diagnosed.

JAN. ’13 Patient admitted to A. & E. with suspected T.I.A. Stroke team expressed surprise that monitoring had not been put in place by G.P. as blood glucose reading was quite high.

JUNE ’13 Routine home-visit by Community Matron. Blood glucose reading was 30. Patient taken to A.& E. by ambulance. No treatment was given & patient was returned to the care of his G.P.

7 months later having tried & discontinued Metformin (unacceptable side-effects re overflowing stoma bags), Gliclazide (max. dose) + Sitagliptin have now been joined by a daily injection of insulin. The readings need to come down still further.

QUESTION Could this 79 year old, with complex health problems (including dementia}, have been spared any of the trauma he has had to endure during the last 18 months if the diabetes had been managed/monitored when first diagnosed rather than left until it became an emergency?

Thank you, M.V. H

Dear M V H,

Thanks for being in touch. It is very difficult to understand how it could be that this patient’s obviously severe diabetes went untreated for 18 months. So the short answer to your question is certainly yes.

Dr Le Fanu"s on the web well being clinic, Friday 24th January 2014